BOARD MEMBERS PRESENT:  Steve Kuhn, P.A.-C, President; Russell Bishop, Psy.D., Secretary; Julia Fullerton, J.D.; Jean Gastiger, R.N., F.N.P.; Mike Groark, J.D.; Rosemary Lane, M.D.; John Olson, D.D.S.; Mary Beth Shear, M.D.; Steve Wolf, R.N.

BOARD MEMBERS ABSENT: Carl Heinisch; Debra Schelkopf, D.V.M. 

MINUTES

On a motion by Dr. Bishop, seconded by Dr. Olson, the minutes of the Board of Health meeting of January 25, 2005, were approved.  Motion carried.

DIVISION REPORTS

Mrs. Grush reported that a great deal of time has been spent on bioterrorism and progress is being made.  On March 8 and 10, 2005, the Bioterrorism Plan was trialed that included staff checking in at the staging area at the Health Department and being transported to the Convocation Center for a tour of that facility.  Others that participated included department heads of DeKalb County, surrounding local health department staff and Mr. Kuhn, Board of Health president.  This event went exceptionally well, and work will now be done on refining the Plan and making some changes.  Mrs. Grush feels our agency is further ahead than a year ago, and probably ahead of surrounding counties in terms of planning.  The biggest issue remains finding the staff to work at an event.  She stated that Health Department staff are to be commended for their effort on this project.

Mrs. Grush reported that Dr. Dubrick of DeKalb Clinic called expressing his concern about the challenges of serving clients through the Prenatal Referral Program, which has been administered by the Health Department for the past 20 years to assure that women receive early prenatal care, with clients distributed evenly among community providers.  About 350 women are referred each year.  Dr. Dubrick’s concern was that there may not be enough providers for the referrals made with DeKalb Clinic down to two obstetricians (and the potential that one of them may be leaving) and with Dr. Hirsch leaving the community.  Another factor is that these clients typically have higher no show rates and there are often language barriers.  He was requesting that prenatal clinics be held at the Health Department with our employees providing the clinic staffing and the local physician providers rotating the clinics.

A meeting was held with providers and issues discussed.  Mrs. Grush surveyed health departments in Illinois which showed that only one that is not a federally qualified health center (FQHC) offered space to a private physician.  No other health departments provide prenatal care.  Mrs. Grush indicated that our agency does not have enough staff to work obstetrics clinics, as all staff are fully committed to agency programs.  She feels it would be of significant expense to the agency to have these clinics and is not aware of any funding to subsidize them.  Another concern was liability since current services provided are considered low risk and the County is self-insured.  The physicians at the meeting indicated this service would increase our risk even if the agency were not part of the delivery process.

Mr. Wolf asked if Dr. Dubrick would come to the Health Department to staff the clinic.  Mrs. Grush responded that physicians would rotate.  She cited the problem of the physician being called out to deliver a baby during a clinic, which could result in clients left waiting and not being seen that day.  She did speak with a couple FQHC about problems and they reported that, generally, it is that one physician does not assume responsibility for the program and that there is not one uniform standard of care nor one set of protocol that all physicians follow.   If the clinics are run by a nurse, they frequently need to call the physician, with clients frequently being sent to the Emergency Room because no one physician assumes total responsibility for the client. 

Mrs. Grush reported that the meeting ended with all physicians feeling that they should continue as is for now with a re-evaluation in six months.  Mrs. Grush, however, feels that Dr. Dubrick would still be interested in coming to the Health Department and seeing clients here even though he is aware we do not have staffing to assist him. She does not see the benefit of holding prenatal clinics at the Health Department as it would, most likely, not change the show rate.  She got the impression at the meeting that physicians feel those in the community that are delivering babies are able to handle the numbers at this time. 

Mrs. Grush cited another problem in that, historically, after the delivery, the mother and baby enter into the care of the clinic that delivered them for pediatric care. If only one physician delivers at DeKalb Clinic, the number of babies being referred to pediatrics would be reduced.  Discussion followed on the decreasing number of physicians at area clinics and the reasons some of them are leaving.

Dr. Olson asked if DeKalb Clinic would drop out of the referral program if the Health Department did not offer them space.  Mrs. Gastiger stated that a smaller number of women would be seen with only one physician providing the service.  Mrs. Grush did not know if DeKalb Clinic would drop out of the program, but did indicate that the next alternative would be to refer clients to Crusader Clinic in Rockford or Belvidere.

Mrs. Grush stated that she feels the Board should discuss the issue now so she can respond to Dr. Dubrick.  If allowing him to see his patients at our site would solve the problem and if he brings his own staff, she has no problem with it.  Dr. Shear added that he was probably prompted to propose this as a solution with the other DeKalb Clinic obstetric staff leaving and trying to look for ways to make his hours more efficient. 

Mrs. Grush reported that there are two exam rooms that were being used by TriCounty, and occasionally by Well Child and Family Planning, that would be available.  However, she reiterated that the Health Department does not have the staff available to work these clinics.

Mrs. Grush did point out that the bus comes by the Health Department, so the show rate could be better here.  Dr. Lane asked how many clinics Dr. Dubrick was considering.  Mrs. Grush stated that it would be one or two times a week.  Mrs. Gastiger added that many of these clients would not miss work to go to an appointment and don’t have transportation to get there.

Mr. Wolf asked if there was grant money available for such a project, and Mrs. Grush responded that there was not, adding that DeKalb County would most likely not be a candidate for such funding even if it were available.

Dr. Lane made a motion authorizing Mrs. Grush to negotiate with Dr. Dubrick the establishment of clinics for clients in the Prenatal Referral Program at the Health Department, seconded by Mr. Wolf.   Motion carried.

Mrs. Grush reported that the 2003 statistics for teen births were recently released by the Illinois Department of Public Health.  In 2003, the number of babies born to Illinois teenagers declined for the ninth straight year and to a record low. 

Mrs. Grush reported that an agreement has been signed with Ben Gordon Center to provide behavioral health services at the Health Department, with a Gordon Center counselor in our agency weekly.  Allowing other agencies to provide services at the Health Department makes it more accessible to the individual and being familiar with our agency makes resistant clients more accepting of referrals.  

Dr. Olson asked about the renovation of office space in the expansion area and the ordering of special door frames.  Mrs. Grush responded that the hall wall was wider than standard resulting in special door frames needing to be ordered with a five-week wait.  The additional expense was $75 with the five-week wait or a charge of $300 if she rushed the change.  She went with the $75 cost for the five-week wait.

Another building issue was the installation of an air conditioner in the mechanical room that houses much of the agency’s computer equipment.  When the facility was built, the transformers, which blow 110º heat, were put inside the mechanical room instead of outside the building.  At some point, the hatch that allowed the additional heat to escape from the electrical room to the attic was removed, which resulted in the room not meeting fire rating codes.  Consequently, the hatch was replaced and air conditioning installed at a completed cost of $7,000. 

Mr. Drake, Director of Environmental Health, reported that well permits were down because of fewer subdivisions being built.  He reported that he testified in court for two days regarding a subdivision that was not in the comprehensive plan, with the County winning the case.

Mrs. Lux, Director of Personal Health Services, reported that the new structural change in the FCM/WIC Program (Family Case Management/Women Infants and Children) began in February, with Bette Chilton (former WIC coordinator) assuming the new position of FCM/WIC coordinator.  Mrs. Lux is happy to report that, so far, it has turned out very, very well and some of the benefits have already been realized.

Mrs. Baj, Director of Home Care, reported that much work has been done in the past two months on the new HIPAA Security Policies and Home Health policies. 

Mrs. Zanellato, Director of Health Education, reported that the school programs are in full swing.  The new part-time health educators hired are doing a great job.  DeKalb County has four more smoke-free restaurants for a total of 76.  Prior to the training of staff at the Convocation Center in March, the call tree system of all Health Department staff was tested with a strong response rate of 87%.  Since this was the first time this had been tested, a lot was learned and changes are being made.  Mrs. Grush added that staff was asked during the test if they could report to work on Saturday, and she felt positive that most staff responded they would be able to report. 

FINANCIAL DATA 

On a motion by Mrs. Fullerton, seconded by Mrs. Gastiger, the Financial Statements for the months of January and February 2005 and the Claims for the months of February and March 2005 were approved.  Motion carried.

NEW BUSINESS

FY2004 Audited Financial Statement

Mrs. Grush reported that the FY2004 audit has been completed, with approximately $200,000 excess revenue over expenses.  She pointed out that the excess revenue will go into the building fund, which now places that at $1.2 million. 

Regarding 2004 Revenue, 5% more was received in Property Tax.  Environmental Health programs generated $11,000 more with the fee increases.  The FCM match increased significantly because IPA started paying quicker and all four quarters were included instead of three quarters.  Home Care  Medicare was up over 2%, and Grants increased by approximately 8%.  Mrs. Grush pointed out that this is somewhat misleading because of the way the grants were paid last year.  The decline in IPA revenue was attributed to the fact that this was the first year the agency did not bill for vision and hearing services because of HIPAA requirements.  Fees were down by about 10% because of the reduction in flu shots administered.  Only 2,000 flu shots were given this year versus almost 6,000 in previous years.  Interest income was down 6.5%.  Revenue from the Public Building Commission (PBC) was up significantly because of building maintenance.  Overall, revenue was up by 4.7% and expenses up 5%. 

In regards to 2004 Expenses, Salaries were up by 3.5%.  The agency also had expenditures for three large projects.

Dr. Bishop asked if the difference in timing indicates that the current budget could be less.  Mrs. Grush responded that this could happen this year with the PBC giving us $157,000, decreased growth in the FCM Federal Match and anticipated increases in Personal Services line items due to the salary increase given to nurses.  Mrs. Gastiger asked when changes in the Federal Budget would affect us, and Mrs. Grush responded that we would not experience this until July 2006.  She added that, currently, the Federal budget is not cutting Medicare and Medicaid but may cut it later with the anticipated Social Security problems. 

Mr. Wolf asked if property tax revenue was being received before he came on the Board.  Mrs. Grush responded that there was several years the agency did not receive property tax revenue as the agency did not really need this revenue source to pay the bills.  However, when the tax cap resolution passed, the Public Health Levy was reinstituted.  If it had not been reinstated at that time, it would have been very unlikely that it would have been reinstated later.

If all anticipated revenue is received, the 2004 Fund Balance is $2,922,091.  The average annual cash on hand is $2,205,587, with approximately $700,000 due to the agency.  Mrs. Grush pointed out that $1.2 million is being set aside in the Building Fund.

Solid Waste Program

Five Year Plan Renewal and Annual Report

Every five years, the Solid Waste Plan must be updated and approved by the DeKalb County Board.  Mrs. Grush explained that the program came into existence ten years ago and the Health Department was authorized to administer the plan.  She pointed out that the citing of landfills, however, falls under the Planning and Zoning Department.

Dr. Olson asked if we would still conduct this plan if Cortland assumed management of the landfill.  Mr. Drake indicated we would and we would also still receive the tipping fee.  Mrs. Grush added that this plan will be approved at the next County Board meeting after approval by the Board of Health tonight.

The recycling rate for 2004 was 51% and 43% without concrete and demolition materials, which is still well above the state average of 25%. 

This year, 83,000 tons were put into the landfill and the flood last May increased what was already at the landfill.  Last year, Waste Management West projected there was 14 years left in the landfill, but because of the flood this year, they are now projecting 10.4 years.

Mrs. Gastiger asked why the construction demolition waste had dropped significantly.  Mrs. Grush responded that projects requiring concrete/demolition that drove the numbers up have not been as abundant as they were a few years ago. 

Mr. Groark recommended approval of the Five-year Update of the Solid Waste Management Plan, seconded by Mr. Wolf.  Motion carried. 

Adoption of HIPAA Security Policies

Adoption of HIPAA Security Officer(s)

The second aspect of the Health Insurance Portability and Accountability Act (HIPAA) Act of 1996, the Security Rule, requires that a Security Officer(s) be named by the agency’s governing board.  Mrs. Grush recommended the appointments of Lisa Baj as Security Officer for Home Care and Karen Hills for Public Health.  A job description was included in the board packet.

The HIPAA Security Policies were presented.  Mrs. Grush stated that the Security Team has been meeting and developed these policies to ensure that the facility is in compliance in regards to the security of electronic protected health information through administrative, physical and technical safeguards.

Mrs. Fullerton moved to approve the recommendations of Lisa Baj as Security Officer for Home Care and Karen Hills for Public Health and approval of the HIPAA Security Polices, as presented, seconded by Mr. Groark.  Motion carried.

Home Health Program Annual Review

Administrative Overview

An annual review is required of the Home Health Program by the governing body, the Board of Health, to ensure compliance with the federal government.  The review shows that revenue increased 1.5% over 2003.  Total visits were down somewhat, but the number of Medicare patients increased.  Mrs. Grush pointed out that we will probably lose money on insurance patients because of their numerous requests for additional information.  She pointed out that records are reviewed quarterly and quality assurance is conducted on charts.   

Personnel Policies

The Personnel Policies of the DeKalb County Health Department were reviewed.  Revisions were made to the areas of application, physical examinations, work week, classifications, payroll period, employment above the entrance level of compensation, yearly wage adjustment and merit increase, differential, health insurance, life insurance, Illinois Municipal Retirement Fund, Deferred Compensation Plan, vacation, sick leave, employee evaluation, discipline and discharge, and client complaint.

Home Care Policies Revisions

Revisions and additions to the Home Care Policies were presented for Board of Health approval.  Mrs. Grush pointed out that there were more revisions/additions than in previous years because of the move to laptops in 2004.  (See packet for Board of Health, March 2005)

Board of Health Bylaws Review

Mrs. Grush reviewed the Board of Health Bylaws and did not make any recommendations for changes.

Mrs. Gastiger moved to approve revisions to the the Personnel Policies and Home Care Policies, as presented, seconded by Dr. Shear.  Motion carried.

Dr. Lane announced that she and her husband are leaving the area and apologized for taking a job she was unable to complete.  She stated she did not know at the time she joined the Board that they would be leaving the area and moving to Baltimore in June. 

CORRESPONDENCE AND ANNOUNCEMENTS

Newspaper articles for the months of January and February included that bird flu as the number one threat in the world (according to CDC chief), the retirement of Patt Elliott (home health nurse), a donation to the Health Department from Altrusa, and students receiving a lesson in recycling.

ADJOURNMENT

On a motion by Mr. Wolf, seconded by Dr. Bishop, the Board of Health meeting adjourned at 9:08 p.m.  Motion carried.

Russell Bishop, Psy.D., Secretary

DeKalb County Board of Health